DESCRIPTION: (Applicant's Abstract) HIV infection remains a threat to the health of adolescents with substance abuse in the United States. Recent advances in HIV therapeutics make the early identification of HIV infected adolescents through HIV testing a high priority for public health. Unfortunately, HIV testing faces numerous challenges among adolescents with substance abuse. This mentored clinical scientist development award will prepare David Pugatch, M.D. to design and implement studies with the ultimate goal of increasing HIV testing behaviors in this high risk adolescent population. The award will also prepare Dr. Pugatch for academic leadership in the field of adolescent HIV infection, with a special emphasis on the behavioral issues facing adolescents with substance abuse. Dr. Pugatch is a board-certified pediatrician in his first year on the full-time faculty as the medical director of the adolescent HIV/AIDS program at the Brown University School of Medicine. Dr. Pugatch's special interest in adolescents with substance abuse, as well as his clinical contact with this population, places him in a unique position to complete important studies to elucidate the barriers and facilitating determinants of HIV testing among substance abusing adolescents. Under the direction of on site mentors, Dr. Larry K. Brown and Dr. Timothy P. Flanigan, Dr. Pugatch will undertake advanced training in the behavioral science of health belief models, clinical trial design as it relates to behavioral interventions, community health approaches to HIV prevention, and statistical training adequate to provide the knowledge to carry out these proposed studies. The research project proposed by Dr. Pugatch will examine the barriers and facilitating determinants of HIV testing in adolescents with substance abuse, ages 15 through 25 years. The project will recruit adolescents from inpatient and outpatient substance abuse treatment programs, and from an agency serving homeless/runaway youth. Specifically, the project will: 1) study the applicability of the transtheoretical model of change to HIV testing behaviors in adolescents with substance abuse; 2) develop a behavioral intervention based upon these findings to increase HIV testing behaviors among this population. The results of this research may have broad implications for increasing HIV testing behaviors among adolescents with substance abuse as well as other groups of adolescents at high risk for HIV infection.